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HomeMy WebLinkAbout14224 (19) 1�� CITY OF DIAMOATD BAR DEPARTMENT OF COMMtJNITY dc DEVELOPMENT SERVICES � . 21660 E.Copley Drive Suitc 190 (409)860-3193 Fax(909)861-3117 PRESS `'�"� � BUII.DING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION/ ]., PERMIT �l ' P/C o ADDRESS r eJ 2� S /�V er ��w� DATE �v ?�9 NUMBER �d'�' � � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER o ADDRESS ZONING SEBACKS W CITY ` .�iIP TEL. c� FRONT RW p APPLI A T TEL. REAR p SIDEISIDE STREET RW ❑ CONTRACTOR SIDE ❑ � ADDRESS � PROPO USE � � + CITY � ZIP TEL. $ � ARCFUENGJ f�'(SS���1-a � DESIGNER N . WEL. NO. O. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFRlADD/REM i�neev�Fnu umER p[ruur oF verwm rH�r i�exEMvr�on�niE corrtucror+s u- �arage/CerpoR CENSEUWWRTIEFOLLOWiNOREASON(SEC.7WIABUSINESSANDPROFESSqN9COpE:ANYCITYOR (n COUNIYWNIpiREGURESAPEfiMR7DCAfYSTRUCf,ALTERIMPRDVE,�EMO1151{ORNEPAIHIWYSTRUC• w patlo/Deck 7URE,PRqN TO ITS 163UANCE.K50 REW RE9 TNE MPLICANT FOq BUCH YERMIT TO FlLE A SIONED iGiFIAEM T}1AT HE OR&IE t9 UCENSEO PURSUANT TO THE PROVISIONS OF THE CONTMCTORS ll• CENSE UW(CFNPTER f(COYMENCINO WITH SECTION 700U)OF DNISION]OF THE BUSINES9 AND PR0. u' POOUSpB FESSIONSOOUE)ORTWRHEORSNEISEI(EM�TTHEREFqpAAND7NEB�S15f-0RtXEAl1EOEpE%EMP- (� iION.ANYVIOLA7qNOF8ECT10N7W�.6BYANYAPPLICMITFORADER1A176UB1EMSTMEAPPLMaW7i0 Z q�q� � 11 CML►ENALTY OF NO'T MOpE T/1M1 FME XUNORED�OLLARS({600).�: � OL�SO'M�EROFTHEPROPERTY,ORMYEMPLOYEESNATNWAGESASTiEIH50lECOMPEN3ATqN, C� Cammerclai � WILL DO TNE WORIf,AND TME STRUG7URE IS NOT INTENDED OR OFFEHED FOR SALE(SEC.7Mt,BUSI- J NESS MlD PRDFESSIONS COOE:hIE COMTRACTONS UCENSE LAW DOES NOT APPLY TO AN OWNER OF � PIqPERTYNM1iOBUpD90RIMPROVE3TNEREON,ANUNh1000ES8UCHWORKMMSELFORHERSELFOq � � 7Hq0U0M MS OR XEN OVM BdPLOYEES.GROVIDED THAT SUCN IMVROVEMENiS ME NOT M1TEN�ED OR m OFFENFb ibR SALE IF,HON�EVER7ME BIILdN00i11YPR6YEMEM IS 50L�WI7HM ONE YFAROF COYPLE � TION,THE ONNER-BUIIDER WILL IIAVE TFIE BURDEN OF VROVINO T/AT HE OR SHE DID NOT BUILO Oq IMPROVE FOR THE PURP06E OF SALE). w OI,ABONMEROFTHEPROPE/RV,AMEXCLl13iYELYCONTRIlC71NGNAhiLICENSEDODMi'RAC70R9 ll� TO CON57RUCT 1HE PiIOJECT�9EC.Twr,BUSINESS AND PROFESSIONS CODE:TNE CON7R1C70RS LI• V91Ufi11011 ADJ.AREA � CQISEUWDOESNOrAPPLYTOMIOYlNEROFAPflOPERTYMfF1OBUILDSORIMPrypyE9THEREdN,AN� � NT7000NTRACTSFORSUCHVRQlECf5WRN11G07�RACTOR(5)UCENSEDPURSUANTTOTIiECONTMG OUAIJTITY DESCRIPTION FEE � Tons ucv+se u�w.�. . • ' ❑I AM EffEMpf UNDEN SEQ B.�P.C.FOR TNI5 HEASON � � � U �= D117E OWNER U � LICENSED CONTAACTORS DECLARATION � IlIEREBYI1FFUiMIM'DERPENAITYOfPERJURVTHA7IAMLICENSEDUNDERPNOVISION50FCHMTER V. � �(COMMENCING WITH SECTKIN 70W)OF�NISION]Of TME B1151NE5511N0 PROFESSIONS CAOE,ANO � �� W LICENSE IS W FULL FORCE AND EFFECT o �j g7�G�_��,�.No. Z� ��t �~ DATE `��"" �_ CONTHACTOH 0. �\�„JWORKERS'COMPENSATION LARAT N � � I HEAEBY�iRM UNDER PENKN OF PERJURY ONE OF THE F'OILOWING DECUMTIONS: Z � _I NAVE MID MALL MIJNTAW A CERTIFICATE OF CONSENT TO SELF-IHSURE FOR NfORKERS' � � Cl�YPENSATION.ASPROVIDE�BVSECTION97000FTHELABORCOOE,FOHTHEVERFOpMANCE C,.� Q TNE WOflN fOR WMlpl THIS PERMIT 1815&UED. � Q 1 NAVE MD YYILLMAINTNN WORI(ER9'COMPENSATION IN5UMNCE,AS REWIRE�9Y 9ECTION � I'� � �C 7000FTFIELABOROODE.FOR7HEGERFORM+WCEOFTHEWORKFOHWMICHTHISPEFUAITI3 (/ SUED.MYWORKEPS'OOMPENSATIONINSURANCECANq1ENANDPOLICYNULIBERME: CONSTRUCTION �� � RRIER C i.�� PLAN REVIEW � �crNu►�een '� 0• �_ ELECTRIC _ (IHICSEC110JNFIDhqTSEaoMF'lP�maFnEPE(MfsFORaHEFU�REnoOluiR5lt�aola��FSS� PLUMBING �y yyy, Z I CER7IFYTHAT MI THE PEKFORMANCE Of TME YYORN FOR WNICX THIS PERMIT IS ISSUED,1 1AECHANICAL � {J� ■[■ (� 6FIhLl NOT EMPLOY ANY VERSON IN ANY AMNNER SO AS TO BECOME SU&IECT 70 THE Uj MIORKERSCOMPEN9ATIONUWSOFGILIFORNIA,MlOAOREETHATIFISHWlD6ECOME INSPECTIONFEE 5 SURIECT TO THE NIORKERS'COMPENSATqN lOVI510N5 OF SECTqN 77W OF THE UBOR /' COOE,I SHALL FORfHW17H CAMPLI'YVI1H T SE PROVISIONS. ISSUANCE � (,./ � i SMIP _ �_ s�v p DATE:����APPLICAM: __ _ � ENERGY P/C W�pNINGFALURENSECUREWORNERS' ENSATION EiiA4EISUN WFUL,IWO ALLBE � SUBJECTANEMPLO`/EHTOCflIMINILLGENAL su+ocm� NESUFTOONEHUNOREOT USAND ENERGYPERMIT � DOLURS(f1 ao,oao),Rl ADDITION TO THE CO i OF COMPENSATION,OAMA6E5 AS PROVIDED FOR IN � SECTION370lOFTIEUIBORCODE.NTEREST,ANOA7TORNEMSFEES. RETENTIONFEE: OCON3TRUCTION LENDINf3 AGENCY PRE•ALT FEE: � 1 HEREBV AFFIRM UNDER VENAL7Y OF PERIURY THAT THERE IS A CONSTRUCTIDN IEN�IH�AOENCY � FOR TFIE PERPDRMANCE OF THE WORK WFl WHICH THIS FERMIT IS ISSUED(SEC.7oG7,CIY.C.). Z W � LENDEWSNANE � LENDER'SADDRE53 � ICER7IFYTNATIHMEREM7HISAPPIJCATIONANDSTIITETHATiHEABOVEINFOFMA7qNI5CORRECT. TOTAL FEES d IACSREE TO COMPLY WITH ALL CfTYAND COUN7Y ORD�NANCESAND STATE LAWS RELATpYO TO BUtlDINO � CONSTRUCTION.AND MEREBY AIJTFiORIZE REVRESENTATIVES OF THIS COIINTY TO ENfEN UPONTHE A90VE•61ENTIDNE07RO�ERTYPoA WSPEC7'IONCJRPOSES. � �' COMMENTS t , �� � PE ENIWE fJn/ tl� /� � 'n �^^7_��.'!'/% � URE OF Y T�7�� p14T � RECPT.NO. PAI�BY VAUDATION WHITE—Deperlment Copy,YELLOW—Finance Copy,PINK—Assassa Copy,GOL�NROD—File Copy,GREEN—ApplicanPs Copy � • . . ,��_; . . . , . .� . . .., . . . • a.,. ,. .. � . . . .. _ , .. , �'� ����, ci-�v oF a��r,nvr�o ���a , ra _.._.i + i��sPcc-�ior� �Eco�D , .. _. .�...�. . _,.�_ . .__.�, _.�__. ..,._�_ __ . .�, _ .�. L y�. g . . _ .. _ , . ,. �. 5i j 1 _..r.. �.'P�~�..�ew.R'tt'''„�l������rv . ...��lM��' �.SY��'� `� �° W�,� ���'� �' � 4 ��` y� �,���'Sp�� "`��'3. sw�.i�' ...s rw �a4�k-A�r.r� ,,,. � -g.:,.-..o�,a . re . . .. 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